Conference Online Registration Form

Bloom Women's Ministry In-House Retreat

Friday, August 7 and Saturday, August 8, 2026 at Pittsfield Assembly of God
Full Name

First NameLast Name
E-mail
example@example.com
Phone Number
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
I will be attending:
What is your age group?
Do you attend Pittsfield Assembly?
Do you have children that you would like to utilize the on-site childcare for?
Please list the name and age of your child (or children) that will be needing care.
How did you hear about this women's retreat?
Click "I agree" below if you understand that your registration is not complete until payment is submitted.
Early Bird Pricing: $30.00/ea (deadline July 19)

Regular Rate Pricing : $40.00/ea

The final deadline to register and pay is July 26, 2026.
Please pay on the page you are redirected to upon clicking "submit" on this form. From the dropdown options, please find "Women's Ministry."

Enter your information and complete payment. You will receive a final confirmation email from us when your payment has been processed. Please allow us 5-7 weekdays to follow up with you!
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Bloom Women's Ministry In-House Retreat